Renal cell cancer metastases to esophagus and stomach successfully treated with radiotherapy and pazopanib

Abstract

Renal cell cancer has been rarely reported as a cause of gastric or esophageal metastases. They usually present with gastrointestinal bleeding and most cases have been managed surgically or endoscopically. We report the case of a 38-year-old man with a 4-year history of metastatic renal cell carcinoma admitted to the emergency room with melena and anemia. At endoscopy, three esophageal polypoid lesions (middle and distal thirds) and a 7 cm mass in the gastric fundus were identified. Biopsy revealed esophageal mucosa infiltrated by renal cell carcinoma. Radiotherapy was administered (30 Gy in 10 fractions), followed by pazopanib, with excellent tolerance and without new bleeding episodes. Computed tomography scan showed complete disappearance of the esophageal and fundic lesions at 3 months follow-up. Twenty-four months after being initiated on pazopanib, there is no radiological evidence of disease. This is the first reported case showing complete remission of gastric and esophageal metastases after treatment with radiotherapy and pazopanib.

Gastric and esophageal metastases in renal cell carcinoma: systematic review and management options

“…Most GM were single, had a polyp-like appearance, measured between 3 and 4 cm, and developed more often in the upper two-thirds of the stomach, especially in the body. As far as we know, only six cases of EM of RCC (including our case) have been reported worldwide since 1960, with dysphagia and hematemesis as the most usual presentations [7,[18][19][20][21], and this is the first review on the topic ( Table 2).…”

“…For actively bleeding but endoscopically resectable lesions (i.e., limited in number and B2 cm), endoscopic resection (i.e., ESD) seems the best option. For non-bleeding lesions, endoscopic resection is still the best option, although starting a molecularly targeted agent without a prior local treatment could also be considered, as was shown in two cases treated with sunitinib and everolimus [24,25], assuming, however, a potential risk of gastrointestinal bleeding [7,69]. Indeed, it is well known that inhibition of vascular endothelial growth factor receptor (VEGFR) augments the risk of bleeding (epistaxis, hemoptysis, and GI bleeding) [70][71][72][73][74], with three large meta-analyses demonstrating a higher risk of bleeding [72,73] and fatal adverse events (most of them attributable to bleeding) [74] with the use of VEGFR-tyrosine kinase inhibitors (VEGFR-TKIs) in metastatic solid tumors.…”

Radiotherapy and Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitors in Renal Cancer

“…Only 1 case report observed a complete response of gastric metastases from renal cancer treated with pazopanib and RT (30 Gy in 10 fractions) [42]. Other studies investigated the RT-pazopanib combination in soft tissue sarcoma [43], breast cancer [40], and in 1 case of radiation recall dermatitis [44].…”

Gastric metastasis of renal cell carcinoma 20 years after radical nephrectomy

“…[5] In the English literature, in 50 cases with renal cell carcinomas, gastric metastases were reported. [1][2][3][4][5][6][7][8][9][10][11][12] Median age of the cases was 66.5 (38-87) years. As is seen in our case, it is more frequently detected in men.…”

“…[1,3] Up to now we could detect only a total of 50 cases in the literature. [1][2][3][4][5][6][7][8][9][10][11][12] In only 4 of these cases gastric metastases developed 20 or more years after diagnosis of renal cell carcinoma. [5,8,12] In this article we presented the 5 th case with gastric metastasis of renal cell carcinoma 20 years after he had undergone radical nephrectomy because of renal cell carcinoma.…”